Maternal Health During the COVID-19 Pandemic in the United States: An Interrupted Time-series Analysis

Abstract

Background: The COVID-19 pandemic, and subsequent policy responses aimed at curbing disease spread and reducing economic fallout, had far-reaching consequences for maternal health. There has been little research to our knowledge on enduring disruptions to maternal health trends beyond the early pandemic and limited understanding of how these impacted pre-existing disparities in maternal health.

Methods: We leveraged rigorous interrupted time-series methods and US National Center for Health Statistics Vital Statistics Birth Data Files of all live births for 2015-2021 (N = 24,653,848). We estimated whether changes in maternal health trends after the onset of the COVID-19 pandemic (March 2020) differed from predictions based on pre-existing temporal trends. Outcomes included gestational diabetes, hypertensive disorders of pregnancy, gestational weight gain, and adequacy of prenatal care.

Results: We found an increased incidence of gestational diabetes (December 2020 peak: 1.7 percentage points (pp); 95% confidence interval [CI]: 1.3, 2.1), hypertensive disorders of pregnancy (January 2021 peak: 1.3 pp; 95% CI: 0.4, 2.1), and gestational weight gain (March 2021 peak: 0.1 standard deviation; 95% CI: 0.03, 0.1) and declines in inadequate prenatal care (January 2021 nadir: -0.4 pp; 95% CI: -0.7, -0.1). Key differences by subgroups included greater and more sustained increases in gestational diabetes among Black, Hispanic, and less educated individuals.

Conclusion: These patterns in maternal health likely reflect not only effects of COVID-19 infection but also changes in healthcare access, health behaviors, remote work, economic security, and maternal stress. Further research about causal pathways and longer-term trends will inform public health and clinical interventions to address maternal disease burden and disparities.